Efficacy of Medical Device Alarm Integration into a Simulated H-60 Integrated Communication System.

INTRODUCTION: This study sought to examine the efficacy of integrating medical device alarms into the intercommunication set of a simulated HH-60, allowing medics to hear the alarms over the ambient noise of the aeromedical environment. MATERIALS AND METHODS: U.S. Army critical care flight paramedics were recruited as subjects for this study. Subjects participated in two testing scenarios: One with patient monitor alarms integrated into their communication lines and one without integrated alarms (the control condition). Testing took place in a simulated HH-60 interior with two priority-level patients per testing scenario, one on either side of the interior. Subjects provided care to these two patients for 30 minutes per scenario. After both scenarios were complete, the subjects were given a questionnaire to obtain their feedback on alarm integration. RESULTS: Six subjects took part in this study, so the results do not have sufficient power to represent the population. No statistically significant results were found. Looking at the trends in the data, implementing alarm integration showed the indications of reducing reaction time to alarms, decreasing or matching the amount of time spent with the patient monitor, and equivalent amounts of time dedicated to patient treatment when compared to the nonintegrated scenario.The feedback obtained from the subjects provided a list of perceived benefits, drawbacks, and improvements related to the integration of medical device alarms into the intercommunication set. CONCLUSIONS: Although the study was underpowered, the trends in the data indicate a benefit to the medics when integrating medical device alarms. When coupled with strongly favorable end-user feedback, the results provide justification for pursuing the effort of integrating alarms and performing future studies with improved integration systems to optimize the potential of the system.

Non-Linear Device Head Coupling and Temporal Delays in Large Animal Acceleration Models of Traumatic Brain Injury.

Accurate characterization of head kinematics following an external blow represents a fundamental aspect of traumatic brain injury (TBI) research. The majority of previous large animal studies have assumed an equivalent relationship between the device delivering the impulsive load and subsequent head kinematics rather than performing direct measurement (sensors or videography). The current study therefore examined factors affecting device/head coupling kinematics in an acceleration TBI model. Experiment 1 indicated ~ 50% reduction in peak angular velocity for swine head relative to the device, with an approximate doubling in temporal duration. The peak angular velocity for the head was not significantly altered by variations in restraint device (straps vs. cables), animal positioning or body mass. In Experiment 2, reducing the impulsive load by 32% resulted in only a 14% reduction in angular velocity of the head (approximately 69% head/device coupling ratio), with more pronounced differences qualitatively observed for angular momentum. A temporal delay was identified in initial device/head coupling, potentially a result of soft tissue deformation. Finally, similar head kinematics were obtained regardless of mounting the sensor directly to the skull or through the scalp (Experiment 3). Current findings highlight the importance of direct measurement of head kinematics for future studies.

17α-Ethinyl estradiol-3-sulfate increases survival and hemodynamic functioning in a large animal model of combined traumatic brain injury and hemorrhagic shock: a randomized control trial.

BACKGROUND: Traumatic brain injury (TBI) and severe blood loss resulting in hemorrhagic shock (HS) represent leading causes of trauma-induced mortality, especially when co-occurring in pre-hospital settings where standard therapies are not readily available. The primary objective of this study was to determine if 17α-ethinyl estradiol-3-sulfate (EE-3-SO4) increases survival, promotes more rapid cardiovascular recovery, or confers neuroprotection relative to Placebo following TBI + HS. METHODS: All methods were approved by required regulatory agencies prior to study initiation. In this fully randomized, blinded preclinical study, eighty (50% females) sexually mature (190.64 ± 21.04 days old; 28.18 ± 2.72 kg) Yucatan swine were used. Sixty-eight animals received a closed-head, accelerative TBI followed by removal of approximately 40% of circulating blood volume. Animals were then intravenously administered EE-3-SO4 formulated in the vehicle at 5.0 mg/mL (dosed at 0.2 mL/kg) or Placebo (0.45% sodium chloride solution) via a continuous pump (0.2 mL/kg over 5 min). Twelve swine were included as uninjured Shams to further characterize model pathology and replicate previous findings. All animals were monitored for up to 5 h in the absence of any other life-saving measures (e.g., mechanical ventilation, fluid resuscitation). RESULTS: A comparison of Placebo-treated relative to Sham animals indicated evidence of acidosis, decreased arterial pressure, increased heart rate, diffuse axonal injury and blood-brain barrier breach. The percentage of animals surviving to 295 min post-injury was significantly higher for the EE-3-SO4 (28/31; 90.3%) relative to Placebo (24/33; 72.7%) cohort. EE-3-SO4 also restored pulse pressure more rapidly post-drug administration, but did not confer any benefits in terms of shock index. Primary blood-based measurements of neuroinflammation and blood brain breach were also null, whereas secondary measurements of diffuse axonal injury suggested a more rapid return to baseline for the EE-3-SO4 group. Survival status was associated with biological sex (female > male), as well as evidence of increased acidosis and neurotrauma independent of EE-3-SO4 or Placebo administration. CONCLUSIONS: EE-3-SO4 is efficacious in promoting survival and more rapidly restoring cardiovascular homeostasis following polytraumatic injuries in pre-hospital environments (rural and military) in the absence of standard therapies. Poly-therapeutic approaches targeting additional mechanisms (increased hemostasis, oxygen-carrying capacity, etc.) should be considered in future studies.

Optimal Physical Space for En Route Care: Medic Posture and Injury Survey.

INTRODUCTION: An anonymous online survey was presented to active duty U.S. Army, Reserve, and National Guard Soldiers with experience as en route care medical providers with the intent of identifying factors which contribute to musculoskeletal disorders in U.S. Army en route care medical providers. The survey looked at transport vehicle design, equipment, and awkward postures that could play a role in causing injuries. MATERIALS AND METHODS: Survey responses were received from 60 en route care providers regarding postures assumed during administration of en route critical care tasks, routine medical transport scenarios, and patient loading. Care providers reported gender, height, weight, experience, tasks, and awkward postures experienced. They also reported occupational injuries that occurred as a result of performing job duties, such as back, neck, and joint pain, injuries, and discomfort. RESULTS: The survey was answered by 56 (93.3%) males and 4 females (6.7%) with an average of 7.34 years of experience as en route care personnel. Lower back injuries were suffered by 87% of respondents. The most common causes were awkward positions and lifting patients. There are statistically significant relationships between shoulder injuries and overextending, lower back injuries and overextending, and lower back injuries and reaching backwards, ankle injuries and care provider height, and knee injuries and the frequency at which care providers utilized the postures of kneeling, squatting, reaching behind themselves, and straining to lift a heavy weight. Loading and unloading patients from evacuation platforms was among the top causes of all awkward postures among respondents. CONCLUSION: Results of this survey emphasize the need for injury mitigation and prevention strategies to reduce impacts on soldier health and readiness.